Has anybody been diagnosed with Microvascular Angina?

I have had this condition for about 4 months and it is really getting on top of me. I sometimes have it all day, with tightness, pain in chest and into my neck, now have a cough. Have trips to ED with tests, but usually normal, except for stress test which I lasted for less than 1 min. They wouldn't let me continue. Had angiogram, normal. Are now on GTN tablet and spray, Diltizem and Atenolol. Have now got Morphine at home to control bad episodes. My life is very restricted, I used to be very active with walking and running, but can now do neither. Sometimes even a flight of stairs is too much. Has anybody got any suggestions?

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Hi, I suffer from coronary artery spasms, similar to what you suffer, angio was clear but am fatigued and suffer neck, chest pain etc. i take isosorbibe mono nitrate which gives me a massive headache (although better after time) but it has helped, also take drug called verapamil, GTN and pain relief. Have hope, when I was first diagnosed in December I was in and out of hospital for three admission by ambulance, thought I was going to die every day... i was terrified of walking upstair to visit the toilet. But as time has gone on, you learn to manage the pain and your stamina will improve, am now back at work part time. Try some CBT therapy too, helps with the panic of your attacks which make the Angina and stress worse. Have faith Priscilla things will get better slowly. I am 46 and before this happened I would run up hills and play football, think nothing of walking our dogs 5 miles. For a while I was chair bound but now this week walked my first mile again! All my best wishes nod prayers to you and others like us out there...

I'm in discussion with my cardiologist about Micro Vascular Angina, Ihave been given the impression this is exactly the same as Prinzmetal Angina which I have been diagnosed with but as usual there ar at least 2 specialists that dis-agree with that diagnosis. My pain isn't every day it comes at least once a week and it was suggested I start a chest pain diary, I can see a pattern involved in all of my episodes,winter time is the worst for me as cold weather and even a gust of wind to the face is enough to set off the prinzmetal angina and the chest pain lasts for ages,I do get relief from using the GTN but there is always that one day where the pain lasts half the day. I have had 2 NStemmis, I have CHD and familial cholesterol also have had 2 suspected TIA's which as you know is completely different from heart disease but works on the same basis as angina but as the doctors call it "Angina of the brain" due to blockages in areteries and vessels leading to the brain. My GP will not prescribe morpheine due to the addictiveness so therefore when I have a bad attack with Prinzmetal angina "Micro vascular angina" I have to call for an ambulance and then morpheine is administered by paramedics or emergency doctors, Morpheine only masks the pain it may get rid of it but it's not fixing the problem and my Cardio specialist has told me it is something I have to learn to live with and if I get to the stage where it becomes unbearable is when I need to call an ambulance.

Nowlybear I have myself tried CBT and it does not work in "Angina instances" well that's what I have found and only my opinion, You speak of "Panic" as a panic/anxiety sufferer of almost half my life you can tell the difference between "panic pain" and "organic pain" that feeling you get with chest pain is normal for everyone you think "oh my what's going on here" or that feeling of "doom" both present in panic attacks and heart attacks..funnily enough I have been fortunate in both my heart attacks, I never experienced that "doom feeling" it was just wham bam you've had a heart attack (mild on both occasions) ECG's were normal but troponins were positive for heart attack

Medications that I am on to try and prevent this rare kind of angina consist of

Cardizem...works effectively

Nicorandil...Works better than Cardizem

Monodur...Didn't really notice any difference

Plavix.. don't see any thing in this medication to relieve Angina as it is only a blood thinner

GTN ..to be used as required I can take up to 30 sprays in one bad episode of Prinzmetal angina, I do get told off by paramedics and emergency doctors for not calling an ambulance after the first 20 minutes of no relief from GTN but I'm at the stage where I'm embarrassed to call for an ambulance as I feel I'm wasting vital resources ...Although I have been told by emergency doctors that I'm not wasting resources because there is going to be "that one day " where someone is going to find me when it's to late....So I fully understand your frustrations.

I am. Now 57 and have been living w/MVD for 10 years. It's tough and yes the angina attacks are the worse. Mine last up to 40 min where it feels like my chest is squeezing tight and sharp intense chest pains and the feeling someone is trying to break my jaw bone in half. It took almost 8 yrs before finally being diagnosed. NO HEART TEST IS CAPABLE OF SHOWING MICROVASCULAR DISEASE! ALL the heart studies are for large coronary arteries, valves & heart muscle. There are a few tests w/altering done that can somewhat diagnose MVD. But there are specific. Meds you need to be on & you need to keep the LIQUID NITROGLYCERIN SPRAY ON YOU, Not the Pills. For one the pills have a very short shelf life and lessen in strength just after 30days. The spray has a year shelf life w/100% potency. Also if you suffer SEVERE angina attacks always take 3-5 baby aspirins just in case it would turn into a heart attack. Those aspirins can save your life! You need to get on the proper meds & chg your life style. Aviod emotional stress if at all possible. Even hrs after an emotional event or even the next day you can suffer an attack. I have never suffered an attack at the time of an event, always hrs later. Sometimes physical stress causes them but most times they occur at rest. Also get a dr to get you on IMDUR. MY DR said there are few meds for this but it's shown IMDUR lessens attacks drastically. I take 30 my daily but had to wk up to that till they settled dwn. I went from having them 4-5!times a week to maybe 10 per year! IMDUR is a timed releasen nitro pill over 12 hrs. You can only take it 1x daily b cause your body needs 12 hrs w/onso you do not become immune to it. Priscilla, Also pain meds, BAD IDEA GIRL!! One a good cardiologist or dr should not prescribe them for this condition or any heart condition for that matter & 2- you could be disguising pain that is actually linked to a heart attack! You need the correct meds & I hope since your posting you are on them. Chk the link I posted above. Great infon& links there in the website. Make sure you find a dr well versed on WOMENS HEART DISEASE! Thgs r different for us. Low estrogen can cause this, thyroid issues and even the history of any pregnancies plays a role here. Ex: if you had High BP or pre eclampsia during pregnancies you have a 40% greater risk for heart disease. Check for anemia, diabetes or if you are pre-diabetic which can be done by a simple blood test. Watch your cholesterol and Wgt. All these thgs have an impact on MVD. MVD has smooth plaque on the micro vessels walls vs the large coronary arteries show lumps on the wall. It's hard to diagnose these vessels just for that reason alone. But basically those vessels constrict frm carbon dioxide and limits blood flow to the heart. If you treat it you won't suffer damage. If left untreated your heart will suffer damage over a period of time and a heart attack will be inevitable. Print out articles from link above and fromMayo Clinic and even Cleveland clinic and the heart association to take yo your dr. But see to it you find a cardiologist, prefer KY female, that is well knowledged on women heart disease and MVD and MVD Angina! This is critical because not every cardiologist is well versed in MVD ( microvascular disease)! They thk if u can't see it then it doesn't exist. But you can see it in an autopsy! So it is real. Good luck and don't stop until u find a cardiologist. I went thru 4! MVD ANGINA hurts like no other! Mine can last up to 40 m where the pain is severe on the highest scale of pain and it always for me will start in my jaw, dwn my arm and to the back of my head then BAM in my chest where I grab it w/intense pain worsening w/ea step I take until I hit the floor or the nearest couch. I have nitro everywhere in my house, 1 in the car & 1 in my purse. I want it available because once it starts you can't think straight because of the pain. The meds don't take them away completely, but you will get your life back trust me. I have a rare auto immune disease and w/IMDUR & nitro spray me life with an too bad anymore .

RESEARCH! Good luck

***Also, Plavix is for high cholesterol which some that have this disease have High cholesterol, which you must have for a dr To prescribe. So stay on it until u are sure cuz you also do not want coronary heart disease which requires heart surgery! Pain meds is probably the worse thg you can do because it can mask your pain to the point Drs can miss somethg and you too. Realize your attack will last up to 30 min even to 40 min. Since you have had TIAs you shoukdntaken3-5 baby as pro SN during the worst angina attacks. Start rating them from 1-4, 4 being unimaginable pain! Like some attacks I literally feel like my body is trying to break my jawbone in 1/2! Try to work thru one before calling life squad since you have a MVD diagnosis. You need to have Liquid Nitroglycerin to spray under tongue. You can use up to 3 times but more u use worse the nitro migraine is. I see you are taking IMDUR, good. It is a slow release of nitro which keeps your vessels open. Only take 1x daily and for me 30 my works. More than that & head kills! Check your other meds and what they are used for. Honestly IMDUR and Ranexa are the only positive treatments for this. You mgt be taking too many conflicting meds making thgs worse. And again, pain meds can make this worse cuz it'll constrict and you don't want that! Also like I said above, watch ur wgt, cholesterol, STRESS, chk thyroid, sugar, etc, but when having an attack you need to breath and try to calm yourself even though it is hurting so bad. It helps a lot. Also control your emotional stress in your life. I learned by avoiding people that stressed me out I lessened my attacks! It's proven that this causes more attacks. MVD is simply the constriction of those tiny arteries which lessens oxygen to your heart and increases dioxide in your blood! Surprisingly my cardiologist was right that learning to meditate and be calmer really does help. W/that and taking IMDUR and keeping nitro spray and baby aspirin near by I managed it. You mgt have to adjust your IMDUR to help alleviate attacks. If they will never be 100% gone sad to say. But you can learn to manage and take control. Find a good female Cardiologist well versed in MVD Angina and female heart disease. They are the best for men and women w/this disease. *** also I am not sure of what you are taking 30 sprays of but if it is nitroglycerin then STOP DOING THAT!!! You shouldn't take over three! This isn't you get headaches. You are suffering from nitro migraines and could have serious consequences w/that amt including heart! Plz stop! It can actually make your angina worse.

Hello, this is interesting, as I am only 49 and finding it hard to not be active. Prinzmetal Angina does seem to be a bit different. My angina mostly only comes on with excersise, be it walking or whatever. I was also told not to turn up at hosp if I could help it, but can do so if I need further morphine. That is all they will give apart from anaesthetic. So I have tried to put up with it. I have had a radio ablation on my heart a few years ago for palpatations. That really helped back then.

After a bad attack, the next day I have a sore chest and also lumps down my throat which goes away in a day or two. I have used the ambulance 3 times, been to hosp more times.

A doctor did tell me that taking morphine does give your body a rest from pain and are very tempted to use it more often, but your body can get 'used' to it too, and what then?

I was told by a specialist that microvascular angina tends to go in cycles, could have it for 5 months, then go away for a length of time then return. I am looking forward to that time!!!

I was around 42 when I was diagnosed with Prinzmetal Angina, first heart attack at the age of 46 and the second one at 49 and the suspected TIA's at 49, Your body can also get immune to the GTN and other trinates.

If your angina seems to only come on with exercise that is generally called stable angina where as prinzmetal comes on whilst exercising or resting,generally though at rest.

I can also relate to you being told not to turn up to the hospital if you could help it, I have had a couple of insensitive paramedics who have made that comment to me but not in a polite fashion either...I follow the emergency room senior doctors advice and that is to get straight back into hospital if the pain comes back and persists, as I commented earlier both my heart attacks weren't picked up on an ECG only by the blood test for troponins...

You most probably have done this but there is a lot of information out there about micro vascular angina ,hence why am going to be having a discussion with my cardiologist as micro vascular is more of the blood vessels with in the heart and not the coronary arteries and give off the same symptoms as prinzmetal angina..My cardio did want to do another angiogram to perform some kind of pressure test in the heart to see what the blood flow was doing but he decided against this as I have already had 3 angiograms and he says that he doesn't want to use that artery in case they really need to use it later on down the track in life....so very frustrating.. I'm limited as to what I can do now as well and have to be vigilant in the colder months.

Cold weather , even extreme heat can be a trigger for coronary artery spasms, even a quick gust of cold wind to the face can set it off, I can't honestly tell you why cold weather is a trigger, it definately sets mine off and is listed in the symptoms and triggers for prinzmetal angina, even emotional stress can set it off, I think that could be said for any type of angina, stress....

Very good articles but I have noticed a lot of researchers have differing views on Prinzmetal Angina, whilst a majority of their research is pretty well the same there are a few with varying opinions on Prinzmetal, I've even come across some research papers where they state it's more prevalent in men rather than women and that it's not always possible to catch episodes by an angiogram or ECG. I've even heard that when the catheter is inserted and worked up through to the heart your arteries will be spasming anyway because they aren't use to having things placed into the artery...

It looks like research from different countries vary even though the specialists all communicate between others ...After reading all the links supplied by me and Emis I have read further readings on Prinzmetal and probably 2 out 4 papers or research differ from each other.....

Thank you for the info, I will check it out. The doctor who did my angio said my arteries didn't spasm during it, but I had just had a dose of morphine before going to the theatre, so would they have done anyway????

Microvascular angina is angina of the micro arteries which don't show on the angio anyway, so may not have had any affect. He was not sympathetic anyway and also told me to throw away the GTN spray and get on with life, so tried to, but my local GP has been very good. But it doesn't seem very common in New Zealand.

I'm not sure of the effects the morphine would of had on the arteries , but you are right about micro arteries they are difficult to pick up/or to being able to see if they spasm on Angiograms and it does state this in the diagnosis guides, it took an AMI for my GP to change his tune and be a bit more sympathetic towards my case. One question if I may, Does the GTN work when you have these episodes ? If it does it usually means it's doing it's job with the problem arteries and blood vessels with in the heart mechanisms, I realise GTN also helps other conditions, the other most notable one is indigestion.

I have to use 2 GTN sprays at a time and they take about 1/2 hour to work then only last for about an hour. They give me a headache for about 5 - 10 mins then I'm okay. Doctors have told me to only use 2 lots of 2 sprays, if that doesn't work to use morphine. I have suggested indigestion to doctors including Hiatus Hernia, but they said it doesn't act that way. Also spasm of the oesophegus, but not in my case. I believe this can be a bad pain too. My pain comes after I get the tightness which spreads to my throat and feels like I'm choking. But have learnt to tolerate this. Morphine works but sometimes makes me vomit, so use as last resort.

Yes GTN will give you a head ache especially if you are using it for the first time or if you don't use it regularly,they will dis-appear when your body adjusts to the GTN , The way I have been instructed to use my GTN is one spray if that doesn't work take another single spray after 5 minutes, The advice given here is one spray of GTN every 5 minutes if pain has not resolved in 20 minutes (4 sprays) to call an ambulance and this is where I run into problems and according to Emergency doctors...I'm playing with my life for not calling after 20 minutes, I persist with the GTN and take nexium and the strongest pain medication I can have is Panamax (Panadol) and I take 1/2 a tablet of Karm (Alprazolam) that doesn't even shift the chest pain , although panamax does get rid of the GTN head ache . I can have up to 30 sprays of GTN before I call for help,the GTN reduces the pain but only by a couple of notches on the pain score, it sits around the 6/10 then drops down to 4-5/10 then creeps back up 5 - 10 minutes after having a shot of GTN. I now call an ambulance when I've had 20 sprays, I have at least one bad episode a week (Prinzmetal Angina) Depends on the paramedics if I get to have morphine for the pain, if they don't administer it then it's up to the treating emergency doctor,they usually write up morphine and it works I usuall end up having 10mg of it before I'm pain free, sometimes it can take up to 15 mg's, The paramedics and doctors have informed me that our bodies can become immune to GTN and morphine if it's used on a regular basis. Yes morphine has that effect on many people ..feeling nauseated or actually vomit. I haven't had to use my GTN for a week today . It's been a good week for me.

You mentioned indigestion...does the GTN help that as well ? I don't mean to alarm you but that symptom you have described is in fact a known and documented heart attack symptom (Warning Sign)..Chest tightness and going to the throat either with a burning or chocking sensation.

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